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      Acute onset polyarthritis in older people: Is it RS3PE syndrome?

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      Author(s): 1 , , 1 , 2
      Publication date (Electronic):
      Journal: Cases Journal
      Publisher: BioMed Central

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          Abstract

          Remitting Seronegative Symmetrical Synovitis with Pitting oedema syndrome, a rare inflammatory arthritis, commonly affects people in the older age group. It can present as an acute onset polyarthritis with associated pitting oedema of the extremities. Patients show excellent response to low dose steroids with complete and sustained remissions. It can also be a paraneoplastic manifestation of an underlying occult malignancy, hence thorough clinical evaluation is warranted.

          We discuss a case of Remitting Seronegative Symmetrical Synovitis with pitting oedema syndrome where the patient presented with acute onset polyarthritis and pitting oedema of the extremities without an underlying systemic cause. Patient showed dramatic response to low dose steroids.

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          Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome.

          David Hunter, J D O'Duffy, Jeffrey Pearson … (1985)
          Eight elderly men and two elderly women presented with symmetrical polysynovitis of acute onset involving most of their appendicular joints and flexor digitorum tendons associated with pitting edema of the dorsum of both hands and both feet. Onset of seven of the ten cases could be pinpointed almost to the hour. Rheumatoid factors were absent from serum samples in all, and no radiologically evident erosions developed. Clinical and laboratory signs of inflammation and the edema disappeared gradually in each case. Treatment consisted of aspirin or other nonsteroidal anti-inflammatory drugs. Hydroxychloroquine, 200 to 400 mg/day, was given in six and gold therapy in two cases. Painless limitation of motion of the wrists and/or fingers persisted in all, although the patients were both unaware of and unhampered by this abnormality. Six of eight cases where typing was possible were positive for HLA-B7, CW7, and DQW2 (relative risk for B7, 9.5). Three cases of this syndrome were found in a consecutive series of 52 men diagnosed as having definite "rheumatoid arthritis," and thus represent a distinctive condition with an excellent prognosis.
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            RS3PE syndrome presenting as vascular endothelial growth factor associated disorder.

            K Aratake, Kenji F. Tanaka, K Arima … (2005)
            To characterise serum concentrations of various cytokines and detection by magnetic resonance imaging (MRI) of synovial hypervascularity in patients with remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome before and after corticosteroid treatment. Vascular endothelial growth factor(165) (VEGF(165)), tumour necrosis factor alpha (TNFalpha), and interleukin 1beta (IL1beta) were measured by enzyme linked immunosorbent assay (ELISA) in serum samples from three patients with RS3PE syndrome. As controls, serum samples from 26 healthy volunteers, 12 patients with rheumatoid arthritis, 10 patients with systemic lupus erythematosus, 13 patients with polymyositis/dermatomyositis, 13 patients with vasculitis syndrome, and 6 patients with mixed connective tissue disease were also analysed. Synovial hypervascularity of patients with RS3PE syndrome was estimated by rate of enhancement (E-rate) in a dynamic MRI study. Serum concentrations of VEGF(165) (mean (SD) 2223.3 (156.3) pg/ml) were significantly higher in patients with active RS3PE syndrome than in controls before corticosteroid treatment. TNFalpha and IL1beta levels were similar in patients and controls. Synovial hypervascularity in affected joints and subcutaneous oedema decreased during corticosteroid treatment, in parallel with the fall in serum VEGF(165). VEGF promotes synovial inflammation and vascular permeability in patients with RS3PE syndrome, suggesting that RS3PE can be classified as a VEGF associated disorder.
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              Remitting distal extremity swelling with pitting edema: a distinct syndrome or a clinical feature of different inflammatory rheumatic diseases?

              Ignazio Olivieri, Carlo Salvarani, F. Cantini (1997)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cases J
                Title: Cases Journal
                Publisher: BioMed Central
                ISSN (Electronic): 1757-1626
                Publication date Collection: 2008
                Publication date (Electronic): 29 August 2008
                Volume: 1
                Page: 132
                Affiliations
                [1 ]Department of Geriatric Medicine, Good Hope Hospital, Rectory Road, Sutton Coldfield, UK
                [2 ]Department of Rheumatology, Mid Staffordshire General Hospital, Cannock Chase Hospital, Brunswick Road, Cannock, UK
                Article
                Publisher ID: 1757-1626-1-132
                DOI: 10.1186/1757-1626-1-132
                PMC ID: 2543002
                PubMed ID: 18759976
                SO-VID: b8c221e1-b876-4076-a0bb-40e3550a978e
                Copyright © Copyright © 2008 Salam et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 June 2008
                Date accepted : 29 August 2008
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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